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Spontaneous intracranial hemorrhage (ICH) occurs rarely during general anesthesia. We report a case of metastatic brain tumor producing an ICH during general anesthesia. A 47-year-old man was scheduled for the wedge resection of left lower lobe of lung under general anesthesia. He did not show any abnormal neurological sign and coagulation abnormality on arrival in the operating room. But he had a history of right hemiplegia 9 months ago which resolved completely. He was anesthetized for about 2 hours. Until 1 hour after the end of anesthesia and operation he did not regain his consciousness, but responded well to external stimuli. He was expected to be better, but his mentality became worse. Immediate computerized tomogram of brain revealed a left ICH. An emergency craniectomy was performed to remove the hematoma. Pathological investigations demonstrated a metastatic brain tumor from liver cell carcinoma. We presume that this intratumoral bleeding was produced by high intracranial blood pressure relating to general anesthesia or obstruction of jugular venous drainage by abnormal positioning of head. (Korean J Anesthesiol 1998; 35: 391∼394)
Background : The dose-related effects of intravenous infusion of propofol on the rat EEG were evaluated quantitatively by spectral analysis of EEG recorded from the rat skull. Methods : Propofol was infused into femoral vein at various concentrations ranging from 0 to 400 g/g body weight, and bipolar EEG was recorded from the rat skull and its spectrum were calculated by power spectrum analysis. The EEG electrodes were fixed at the right and left frontal, parieatal, and occipital bone on rat stereotaxic table. The density of each spectral bands(delta 1 3.25, theta 3.5 7.75, alpha 8 12.75, beta 13 31.75 Hz), total power density, median power frquency, and spectral edge frequency were derived from the spectra. Results : In visual inspection of conventional EEG, low doses of propofol(100, 200 g/100 g) showed no significant changes except appearance of high frequency waves, but higher doses of propofol(300, 400 g/100 g) showed high amplitude with low frequency wave. In quantitative spectral analysis of EEG, low dose of propofol revealed no significant change except appearance of β-waves in the frontal lobe especially. Significant EEG changes were identified during infusion of higher dose of propofol. 300 and 400 g/g of propofol revealed high amplitude and low frequency waves. Median power frequency and spectral edge frequency were significantly changed at 300 and 400 g/g of propofol in range 4.2Hz and 3.8Hz, and 12.4 Hz and 10.2 Hz respectively. Conclusions : Taken together, these findings suggest that analysis of EEG parameters derived from EEG power spectrum could be applied to determine the depth of propofol anesthesia in rats. (Korean J Anesthesiol 1997; 32: 252∼259)
We analyzed 171 consecutive cases}of tumors and tumorous conditions of bone confirmed, roentgenologically and histopathologically at the department of Ort-hopaedic Surgery, National Medical Center since Jan. '67 to Dec. '76. The results concluded are as followings; 1. Of 171 cases, the malignant tumors were 99 cases(57, 9%), while the ben-ign tumors were 58 cases(33.9%), and the giant cell tumors were 14 cases (8.2%). Male had slightly higher incidence than female with sex ratio of 1 : 0.7 and they were most frequent in the age group of the second decade. 2. The number of patients visiting hospital within 1 year after the onset of symptoms was 29 cases(50%) in benign, 77 cases(77.8%) in malignant and 6 cases(42.9%) in giant cell tumor. 3. Of 58 benign tumors, the most frequent tumor was the osteochondroma (50%), followed by the enchondnma (17.2%), the osteoid osteoma(10.3%), etc., of 99 malignant bone tumors the most frequent tumor was the osteos-arcoma(33.3%), and the metastatic bone tumor(27.3%), the chondrosarcoma (11.1%), etc. in order. 4. Pain or discomfort of various character was the most frequent complaint on admission in majority of the cases, and bony protrusion, swelling, etc. in order. 5. The history of trauma was concurrently obtainable in 39 cases(22.8%), more in the benign tumor(25.9%) than the malignant tumor(22.2%). 6. As to the localization of tumor in 1711 cases, a. The most frequent location was found in the lower extremity(57.9%), and the flat bone(22.2%), the upper extremity(14.0l0) and the multiple involvement(5.8%) in order. b. Of 123 cases involving the extremities, the most frequent bone involved the femur(55. 3%) and the tibia(24. 4%, the humorous(10. 6%) in order c. Of 126 lesions on the limb bones, the most frequent site was metaphysis (64.3%.) and diaphysis(20.6%), epiphysis(15.1%) in order. d. In long bone they most frequently developed around the knee joint. Involvement of the distal part of the femur and the proximal part of the tibia was more frequent by 2.6 times(57:22) than that on the proximal part of the femur and the distal part of the tibia, while on the humerus, entire cases(12 cases) involved the proximal part. e. In the involvement on phalanges, the distal part was most frequently in. volved(69.2%). 7. In the primary foci of 27 cases of metastatic bone tumor, the breast(4.8 °o) was most frequent in female, the prostate gland and the liver (3 cases respectively) were in male, but we failed to determine the primary foci in 9 cases(33.3%). 8. Complications during hospitalization were pathological fracture(8.8%), joint stiffness(6.4%), metastasis(5.8%) etc. in order. 9. Surgical interventions were carried out in 84 cases out of 171 consecutive cases; amputation in 27 cases, bone graft after curettage in 22 cases, cure-ttage in 5 cases, transference to the other hospital for radiotherapy in 3 cases and chemotherapy in I case, while 83 patients refused or abandoned any definite treatment.
Background : This study was proposed to examine the effects of butorphanol on propofol dose requirements and hemodynamic responses during propofol-N_2O-O_2 anesthesia. In addition, the effects of butorphanol on the recovery time, sedation score and postoperative first analgesic request time were assessed. Methods: Forty patients were allocated to 2 groups. Twenty patients received butorphanol (20 ㎍/kg, group B) and the others received an equal volume of placebo (group P) 3 minutes before induction with propofol. After induction, anesthesia was maintained with propofol (6 - 10 ㎍/kg, iv)-N_2O (70%)-O_2 (30%). Propofol doses for induction and maintenance and hemodynamic responses (blood pressure, heart rate) were checked. After surgery, sedation score, recovery profiles, and postoperative first analgesic request time were assessed. Results : The induction doses of propofol were lower in group B than in group P. Diastolic pressure and heart rate decreased in group B compared to group P after endotracheal intubation and before skin incision. After skin incision, decreased diastolic pressure and heart rate returned to preanesthetic levels in group P, but the decreased level was sustained in group B. There were group differences in sedation score at 5 and 10 minutes after extubation. In group B, recovery was delayed and more time elapsed before the first analgesic request. Conclusions : Butorphanol co-administered with propofol reduces the induction dose of propofol and delays the first analgesic request time, but there are significant fluctuations in blood pressure and heart rate during endotracheal intubation and skin incision.(Korean J Anesthesiol 2000; 38: 258~264)